Throughout history, sutures have been utilized to capture and retain tissue in approximation during a wound healing period. More recently, metal staples and staplers have been developed to speed the closure process. While both suturing and stapling are effective, they are each prone to infection, unsightly scarring and can require subsequent medical follow ups for removal of the staple by a medical professional.
In a desire to improve upon the existing techniques for wound closure, an approach to wound closure through the insertion of a subcuticular bioabsorbable fastener in dermal tissue is described in U.S. Pat. Nos. 6,726,705, 7,112,214, 7,547,315, 7,686,200, 7,950,559, 8,066,736 and 8,074,857, U.S. Patent Publication Nos. 2012/0145765 and 2013/0267997 to Peterson et al. and U.S. patent application Ser. No. 14/262,071 to Peterson et al., all of which are herein incorporated by reference in their entirety. These devices and methods have been developed and/or commercialized as the INSORB® line of surgical staplers available from Incisive Surgical, Inc. of Plymouth, Minn. By using a subcuticular dermal insertion and fastening approach as taught by the various Peterson et al. references, visible scarring is minimized and incidences of infection are significantly reduced.
In order to have optimal wound closure and healing, it is desired to avoid any piercing of the epidermis and the unintentional placement of the surgical fastener through the external skin surface (percutaneous). This external placement of fasteners is difficult for the practitioner to avoid and requires that that the fastener must be removed. If detected in the operating suite, the removal of the fastener will delay and interrupt the wound closure procedure. If the externally placed fastener is not detected at the time of surgery, it typically requires corrective intervention in a clinician's office resulting in an additional patient follow-up visit. This is a frequent cause of user frustration and increases the cost and inconvenience for both the patient and clinician. As such, it would be advantageous to further improve upon the devices and methods as taught by Peterson et al. so as to reduce or eliminate the risk of fasteners being misplaced through the external skin surface, improve the clinical outcome and clinician and patient experience.